US20160354049A1 - Registration of coronary sinus catheter image - Google Patents

Registration of coronary sinus catheter image Download PDF

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US20160354049A1
US20160354049A1 US14/730,386 US201514730386A US2016354049A1 US 20160354049 A1 US20160354049 A1 US 20160354049A1 US 201514730386 A US201514730386 A US 201514730386A US 2016354049 A1 US2016354049 A1 US 2016354049A1
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model
coronary sinus
heart
image data
coordinate space
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Meir Bar-tal
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Biosense Webster Israel Ltd
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Biosense Webster Israel Ltd
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Priority to US14/730,386 priority Critical patent/US20160354049A1/en
Assigned to BIOSENSE WEBSTER (ISRAEL) LTD. reassignment BIOSENSE WEBSTER (ISRAEL) LTD. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: BAR-TAL, MEIR
Priority to IL245719A priority patent/IL245719B/en
Priority to CA2930682A priority patent/CA2930682A1/fr
Priority to AU2016203605A priority patent/AU2016203605B2/en
Priority to JP2016111676A priority patent/JP6727936B2/ja
Priority to CN201610390607.4A priority patent/CN106236257B/zh
Priority to EP16172805.0A priority patent/EP3100682B1/fr
Priority to ES16172805T priority patent/ES2797786T3/es
Publication of US20160354049A1 publication Critical patent/US20160354049A1/en
Abandoned legal-status Critical Current

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Definitions

  • This invention relates to cardiac physiology. More particularly, this invention relates to the evaluation of electrical propagation in the heart.
  • Cardiac arrhythmias such as atrial fibrillation are an important cause of morbidity and death.
  • U.S. Pat. No. 5,546,951, and U.S. Pat. No. 6,690,963, both issued to Ben Haim and PCT application WO 96/05768, all of which are incorporated herein by reference, disclose methods for sensing an electrical property of heart tissue, for example, local activation time, as a function of the precise location within the heart. Data are acquired with one or more catheters having electrical and location sensors in their distal tips, which are advanced into the heart. Methods of creating a map of the electrical activity of the heart based on these data are disclosed in commonly assigned U.S. Pat. No. 6,226,542, and U.S. Pat. No.
  • location and electrical activity is typically initially measured on about 10 to about 20 points on the interior surface of the heart. These data points are then generally sufficient to generate a preliminary reconstruction or map of the cardiac surface.
  • the preliminary map is often combined with data taken at additional points in order to generate a more comprehensive map of the heart's electrical activity. Indeed, in clinical settings, it is not uncommon to accumulate data at 100 or more sites to generate a detailed, comprehensive map of heart chamber electrical activity. The generated detailed map may then serve as the basis for deciding on a therapeutic course of action, for example, tissue ablation, to alter the propagation of the heart's electrical activity and to restore normal heart rhythm.
  • Catheters containing position sensors may be used to determine the trajectory of points on the cardiac surface. These trajectories may be used to infer motion characteristics such as the contractility of the tissue. As disclosed in U.S. Pat. No. 5,738,096, issued to Ben Haim, which is incorporated herein in its entirety by reference, maps depicting such motion characteristics may be constructed when the trajectory information is sampled at a sufficient number of points in the heart.
  • Electrograms may be measured by unipolar or bipolar leads, and are used, e.g., to determine onset of electrical propagation at a point, known as local activation time.
  • a reference catheter or reference element is placed in contact with the anatomical body.
  • a physical structure within a navigational coordinate system is located using the reference elements or reference catheter.
  • An image reference within an image coordinate corresponding to the physical structure is located. Location of the image reference can be accomplished, e.g., by displaying the medical image and electronically marking the displayed image reference, or by automatically locating image data corresponding to the image reference.
  • the navigational and image coordinate systems are then registered based on the location of the physical structure within the navigational coordinate system and the location of the image reference within the image coordinate system, which allows graphical information to be merged with the medical image data.
  • a reconstruction of the heart is prepared prior to catheterization from cardiac image data, such as CT or MRI data.
  • the reconstruction takes into consideration motion of the cardiac structures such as the coronary sinus due to cardiac and patient motion.
  • the coronary sinus is catheterized and reconstructed using fluoroscopic image data.
  • the reconstruction of the coronary sinus is placed in registration with the reconstruction of the heart, so that the resulting image has a coordinate space consistent with that of a functional electroanatomic images of the heart that may be displayed or generated, for example a CARTO map.
  • Cardiac structures of interest may then be identified on the functional electroanatomic image by an operator.
  • a method which is carried out by importing image data of a heart of a living subject into an image-processing computer system, representing the image data as a first model of the heart and the coronary sinus in a first coordinate space, and introducing a probe into the coronary sinus. Thereafter, the method is further carried out acquiring fluoroscopic image data of the probe, using the fluoroscopic image data to prepare a second model of the coronary sinus in a second coordinate space, and transforming the first model into the second coordinate space by placing the coronary sinus of the second model in registration with the coronary sinus of the first model.
  • the image data is obtained by computed tomography or magnetic resonance imaging of the heart.
  • the first model is a 3-dimensional model.
  • preparing a second model includes reconstructing a 2-dimensional path of the probe.
  • preparing a second model includes estimating a 3-dimensional path of the probe from the 2-dimensional path.
  • Another aspect of the method includes locating a cardiac structure in the transformed first model in the second coordinate space.
  • an apparatus including a cardiac catheter adapted for introduction into a coronary sinus of a heart of a living subject, a display, and a processor.
  • the processor is cooperative with a fluoroscopic imaging device for performing a method, which is carried out by importing image data of the heart into an image-processing computer system, representing the image data as a first model of the heart and the coronary sinus in a first coordinate space, and introducing a probe into the coronary sinus.
  • the method is further carried out acquiring fluoroscopic image data of the probe, using the fluoroscopic image data to prepare a second model of the coronary sinus in a second coordinate space, and transforming the first model into the second coordinate space by placing the coronary sinus of the second model in registration with the coronary sinus of the first mode.
  • FIG. 1 is a pictorial illustration of a system for performing cardiac catheterization procedures, which is constructed and operative in accordance with an embodiment of the invention
  • FIG. 2 is a flow-chart of a method of registration of cardiac images using a coronary sinus catheter in accordance with an embodiment of the invention.
  • FIG. 3 is a composite image illustrating a stage in the process of coronary sinus reconstruction as applied to a 3-dimensional model of the heart, in accordance with an embodiment of the invention.
  • aspects of the present invention may be embodied in software programming code, which is typically maintained in permanent storage, such as a computer readable medium.
  • software programming code may be stored on a client or a server.
  • the software programming code may be embodied on any of a variety of known non-transitory media for use with a data processing system, such as USB memory, hard drive, electronic media or CD-ROM.
  • the code may be distributed on such media, or may be distributed to users from the memory or storage of one computer system over a network of some type to storage devices on other computer systems for use by users of such other systems.
  • Embodiments of the invention enable identifying cardiac structures during the medical procedure.
  • the position of the coronary sinus is accurately known based on fluoroscopy of a coronary sinus catheter, its position can be related to the position of other portions of the heart provided there is a common coordinate system to locate the other portions, the embodiments of the invention place the coronary sinus, as determined from fluoroscopy, in registration with a 3-dimensional model of the heart prepared using another imaging modality.
  • FIG. 1 is a pictorial illustration of a system 10 for performing catheterization procedures on a heart 12 of a living subject, which is constructed and operative in accordance with a disclosed embodiment of the invention.
  • the system comprises a catheter 14 , which is percutaneously inserted by an operator 16 through the patient's vascular system into a chamber or vascular structure of the heart 12 .
  • the operator 16 who is typically a physician, brings the catheter's distal tip 18 into contact with the heart wall at an ablation target site.
  • anatomic positional information i.e., of the distal portion of the catheter, and other functional images may then be prepared using a processor 23 located in a console 24 , according to the methods disclosed in U.S. Pat. Nos. 6,226,542, and 6,301,496, and in commonly assigned U.S. Pat. No. 6,892,091, whose disclosures are herein incorporated by reference.
  • One commercial product embodying elements of the system 10 is available as the CARTO® 3 System, available from Biosense Webster, Inc., 3333 Diamond Canyon Road, Diamond Bar, Calif. 91765, which is capable of producing electroanatomic maps of the heart as required for the ablation. This system may be modified by those skilled in the art to embody the principles of the invention described herein.
  • Areas determined to be abnormal can be ablated by application of thermal energy, e.g., by passage of radiofrequency electrical current through wires in the catheter to one or more electrodes at the distal tip 18 , which apply the radiofrequency energy to the myocardium.
  • the energy is absorbed in the tissue, heating (or cooling) it to a point (typically about 60° C.) at which it permanently loses its electrical excitability.
  • this procedure creates non-conducting lesions in the cardiac tissue, which disrupt the abnormal electrical pathway causing the arrhythmia.
  • the principles of the invention can be applied to different heart chambers to treat many different cardiac arrhythmias.
  • the catheter 14 typically comprises a handle 20 , having suitable controls on the handle to enable the operator 16 to steer, position and orient the distal end of the catheter as desired for the ablation.
  • the distal portion of the catheter 14 contains position sensors (not shown) that provide signals to a positioning processor 22 , located in the console 24 .
  • Ablation energy and electrical signals can be conveyed to and from the heart 12 through the catheter tip and/or one or more ablation electrodes 32 located at or near the distal tip 18 via cable 34 to the console 24 .
  • Pacing signals and other control signals may be conveyed from the console 24 through the cable 34 and the electrodes 32 to the heart 12 .
  • Sensing electrodes 33 also connected to the console 24 are disposed between the ablation electrodes 32 and have connections to the cable 34 .
  • Wire connections 35 link the console 24 with body surface electrodes 30 and other components of a positioning sub-system.
  • the electrodes 32 and the body surface electrodes 30 may be used to measure tissue impedance at the ablation site as taught in U.S. Pat. No. 7,536,218, issued to Govari et al., which is herein incorporated by reference.
  • a temperature sensor (not shown), typically a thermocouple or thermistor, may be mounted on or near each of the electrodes 32 .
  • the console 24 typically contains one or more ablation power generators 25 .
  • the catheter 14 may be adapted to conduct ablative energy to the heart using any known ablation technique, e.g., radiofrequency energy, ultrasound energy, freezing technique and laser-produced light energy. Such methods are disclosed in commonly assigned U.S. Pat. Nos. 6,814,733, 6,997,924, and 7,156,816, which are herein incorporated by reference.
  • the positioning processor 22 is an element of a positioning subsystem in the system 10 that measures location and orientation coordinates of the catheter 14 .
  • the positioning subsystem comprises a magnetic position tracking arrangement that determines the position and orientation of the catheter 14 by generating magnetic fields in a predefined working volume and sensing these fields at the catheter, using field generating coils 28 .
  • the positioning subsystem may employ impedance measurement, as taught, for example in U.S. Pat. No. 7,756,576, which is hereby incorporated by reference, and in the above-noted U.S. Pat. No. 7,536,218.
  • a fluoroscopic imaging device 37 has a C-arm 39 , an x-ray source 41 , an image intensifier module 43 and an adjustable collimator 45 .
  • a control processor (not shown), which may be located in the console 24 , allows an operator to control the operation of the fluoroscopic imaging device 37 , for example by setting imaging parameters, and controlling the collimator 45 to adjust the size and position of the field of view.
  • the control processor may communicate with the fluoroscopic imaging device 37 via a cable 51 to enable and disable the x-ray source 41 or restrict its emissions to a desired region of interest by controlling the collimator 45 , and to acquire image data from the image intensifier module 43 .
  • An optional display monitor 49 linked to the control processor, allows the operator to view images produced by the fluoroscopic imaging device 37 .
  • the fluoroscopic images may be viewed on a monitor 29 , either via a split screen or in alternation with other non-fluoroscopic images.
  • the catheter 14 is coupled to the console 24 , which enables the operator 16 to observe and regulate the functions of the catheter 14 .
  • the processor 23 is typically a computer with appropriate signal processing circuits.
  • the processor 23 is coupled to drive the monitor 29 .
  • the signal processing circuits typically receive, amplify, filter and digitize signals from the catheter 14 , including signals generated by the above-noted sensors and a plurality of location sensing electrodes (not shown) located distally in the catheter 14 .
  • the digitized signals are received and used by the console 24 and the positioning system to compute the position and orientation of the catheter 14 and analyze the electrical signals from the electrodes, and generate desired electroanatomic maps.
  • the system 10 includes other elements, which are not shown in the figures for the sake of simplicity.
  • the system 10 may include an electrocardiogram (ECG) monitor, coupled to receive signals from one or more body surface electrodes, to provide an ECG synchronization signal to the console 24 .
  • ECG electrocardiogram
  • the system 10 typically also includes a reference position sensor, either on an externally-applied reference patch attached to the exterior of the subject's body, or on an internally-placed catheter, which is inserted into the heart 12 maintained in a fixed position relative to the heart 12 .
  • Conventional pumps and lines for circulating liquids through the catheter 14 for cooling the ablation site are provided.
  • FIG. 2 is a flow-chart of a method of registration of cardiac images using a coronary sinus catheter in accordance with an embodiment of the invention.
  • the process steps are shown in a particular linear sequence for clarity of presentation. However, it will be evident that many of them can be performed in parallel, asynchronously, or in different orders. Those skilled in the art will also appreciate that a process could alternatively be represented as a number of interrelated states or events, e.g., in a state diagram. Moreover, not all illustrated process steps may be required to implement the method.
  • a CT (or MRI) image of the heart is obtained. This may be accomplished prior to the current session, but in any case prior to introduction of a cardiac catheter.
  • the image created in this step has a scale and coordinate system that is specific to the image acquisition device employed, which is referred to for convenience as “CT coordinates”.
  • CT coordinate space describes a 3-dimensional space having points described in CT coordinates.
  • the coronary sinus is defined in CT coordinates on the image.
  • the CT image is imported into an image processing computer, e.g., the above-described CARTO 3 system.
  • the imported image occupies CT coordinate space.
  • images normally produced using the image processing computer have another coordinate system and occupy a different coordinate space.
  • This coordinate system and space are referred to herein for convenience as “CARTO coordinates” and “CARTO coordinate space”, respectively. It will be understood that the use of this terminology does not limit the application of the method to the CARTO 3 system. Rather the steps may be performed by many other types of image processing computers.
  • a 3-dimensional model of the heart in CT coordinate space is prepared from the CT image. This can be done using the CARTOMERGETM module, available from Biosense Webster.
  • a coronary sinus catheter is introduced into the coronary sinus under fluoroscopic control.
  • a 3-dimensional path of the coronary sinus catheter may be estimated using epi-polar geometry or iterative reconstruction of linear segments.
  • the patient's heart position is tracked over time.
  • an algorithm reconstructs a path or track of the coronary sinus catheter in three dimensions, based on two 2-dimensional fluoroscopic images acquired before and after a movement, and synchronized in the cardiorespiratory cycle.
  • a transformation between the two reconstructed catheters is computed and used to align the data.
  • the reconstructed coronary sinus is motion-compensated, and exists in CARTO coordinate space.
  • FIG. 3 is a composite image illustrating a stage in the process of coronary sinus reconstruction as applied to a 3-dimensional model 81 of the heart as described in step 55 , in accordance with an embodiment of the invention.
  • a corridor 83 is outlined and sampled around a CS catheter path 85 (represented by a broken line).
  • the catheter path 85 was defined from previous frame and may have been annotated by a human operator.
  • the divergence of CS catheter 87 from the catheter path 85 is compensated by suitable transformations, as explained in further detail in the above-noted application Ser. Nos. 14/621,570 and 14/621,581,
  • the reconstructed coronary sinus is placed in registration with the 3-dimensional model that was prepared in step 55 by aligning coronary sinus 89 in the model 81 with the transformed catheter path 85 obtained from analysis of the fluoroscopic image.
  • the 3-dimensional model 81 exists in CT coordinate space.
  • the model 81 is now transformed into CARTO coordinate space.
  • the CARTOMERGETM image integration module available from Biosense Webster, is suitable for performing the image registration and coordinate transformation. Since the position or the coronary sinus is closely related to the position of other portions of the heart, the remainder of the heart on the model 81 will be in registration with other cardiac images generated and displayed by the image processing computer.

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US14/730,386 2015-06-04 2015-06-04 Registration of coronary sinus catheter image Abandoned US20160354049A1 (en)

Priority Applications (8)

Application Number Priority Date Filing Date Title
US14/730,386 US20160354049A1 (en) 2015-06-04 2015-06-04 Registration of coronary sinus catheter image
IL245719A IL245719B (en) 2015-06-04 2016-05-18 Registration of an image of the coronary sinus
CA2930682A CA2930682A1 (fr) 2015-06-04 2016-05-19 Enregistrement d'image de catheter de sinus coronarien
AU2016203605A AU2016203605B2 (en) 2015-06-04 2016-05-31 Registration of coronary sinus catheter image
JP2016111676A JP6727936B2 (ja) 2015-06-04 2016-06-03 冠状静脈洞のカテーテル画像の位置合わせ
CN201610390607.4A CN106236257B (zh) 2015-06-04 2016-06-03 冠状窦导管图像的对准
EP16172805.0A EP3100682B1 (fr) 2015-06-04 2016-06-03 Enregistrement d'image de cathéter dans le sinus coronaire
ES16172805T ES2797786T3 (es) 2015-06-04 2016-06-03 Registro de imagen de catéter del seno coronario

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